Pediculosis

Pediculosis has affected man for eons. At one time, having lice was a status symhol. Phanostrate, the Egyptian maiden, was so infested with lice that she could be seen standing in the doorway of her home picking off her vermin." Currently, lice ate not a sign of success; however, the Anoplura family cotitinues to proliferate. Unfortunately, we have no methods of hirth control or mass eradication for them. After World War II, little attention was paid to lice and the suhsequent complications. These problems were supposed to have disappeared with the return to peacetime. Even if the body louse could transmit typhus, relapsing, and trench fever, this seemed like a remote happening in the civilized world.^ Authentic pediculosis corporis has become unusual and even a rarity in contemporary America. Phthirus pubis—of, yes, the crabs that nice people do not get; with the sexual revolution, these nice people began to itch in a variety of places. Little old ladies found themselves infested in unlikely areas. Such patients are pruritic and even uncomfortable, but very rarely do they develop superinfection.'' Pediculosis capitis should have disappeared with the war on poverty. It remains an annual problem flaring in the fall and spurting forth through the school year. Little commotion developed until nice children from nice homes attending nice private schools started to scratch. How many of these children really become sick? Mass hysteria accompanies such epidemics. Parents insist that schools be closed. School nurses must spend all of their time "nit-picking," and physicians are driven to concoct some of the most absurd remedies, either out of fear or guilt or ignorance or all three. Pediculosis capitis is an annoyance. No one enjoys seeing insects move over the hair. In our culture, we do

Pediculosis has affected man for eons. At one time, having lice was a status symhol. Phanostrate, the Egyptian maiden, was so infested with lice that she could be seen standing in the doorway of her home picking off her vermin." Currently, lice ate not a sign of success; however, the Anoplura family cotitinues to proliferate. Unfortunately, we have no methods of hirth control or mass eradication for them.
After World War II, little attention was paid to lice and the suhsequent complications. These problems were supposed to have disappeared with the return to peacetime. Even if the body louse could transmit typhus, relapsing, and trench fever, this seemed like a remote happening in the civilized world.^ Authentic pediculosis corporis has become unusual and even a rarity in contemporary America.
Phthirus pubis-of, yes, the crabs that nice people do not get; with the sexual revolution, these nice people began to itch in a variety of places. Little old ladies found themselves infested in unlikely areas. Such patients are pruritic and even uncomfortable, but very rarely do they develop superinfection.'' Pediculosis capitis should have disappeared with the war on poverty. It remains an annual problem flaring in the fall and spurting forth through the school year. Little commotion developed until nice children from nice homes attending nice private schools started to scratch. How many of these children really become sick?
Mass hysteria accompanies such epidemics. Parents insist that schools be closed. School nurses must spend all of their time "nit-picking," and physicians are driven to concoct some of the most absurd remedies, either out of fear or guilt or ignorance or all three.
Pediculosis capitis is an annoyance. No one enjoys seeing insects move over the hair. In our culture, we do Parents must be made aware of how to recognize the condition, just as school health authorities and physicians have learned to diagnose pediculosis. Observation of the louse and its nits can be done with the naked eye. Treatment is easy, and side effects are just about nonexistent.Ŵ e agree that pediculosis is a blasted nuisance, and we have no particular affection for the lice; however, they do not carry disease nor do they rarely cause anything more than itching.

From tbe Division of Dermatology, Medical College of Obio, Toledo, Obio
Significant progress in the diagnostic evaluation and therapy of insect allergy, using venom extracts, has been accomplished in the last few years. Specific venoms, rather than whole-body mixed extracts, of insects from the order Hymenoptera have proven to be beneficial for the testing of specific insect allergies and for hyposensitization.^"^ It is most important that dermatologists continue to be familiar with the recent new developments in the field of insect allergy.
Stinging hymenoptera are the cause of the most serious allergic reactions in humans. The four families of Hymenoptera of clinical significance in insect allergy are: the Vespida (wasps, hornets, and yellow jackets), the Apidae (honeybee), the Bombidae (bumblebee), and the Formicidae (fire ants).'' Nonallergic patients develop only local reactions after having been stung by one of the hymenopterans. Transient pain, erythema, and swelling occur at the site of the sting, lasting for several hours.
All systemic reactions following insect stings are anaphylactic by definition.' Cutaneous reactions constitute the majority of responses and include erythema, pruritus, urticaria, and angioedema. The more serious reactions with potential fatal consequences include upper airway obstruction due to bronchospasm or laryngeal edema, hypotension, vascular or hemorrhagic reactions, and various delayed reactions usually involving the central nervous system. Although most reactions occur within 15 minutes following the insect bite, de- Atopy appears to be a predisposing factor, as it is reported in 33 to 40 percent of patients developing anaphylaxis.""^^ Anaphylaxis is more common in people under 20 years of age" and is seen twice as frequently in men.'^~'^ These two findings probably reflect greater exposure to outdoor environment rather than immunological abnormalities.

Whole-Body Extract Therapy
Since 1930,'^ crushed, whole-body extracts from the various hymenoptera have been commonly used for hyposensitization of patients with a history of an anaphylactic reaction. Whole-body extracts from mixed stinging insects for skin testing have been proven useless in diagnosing allergic sensitivity.^"^ Their use for desensitization has been quite controversial.
Reports of excellent results using whole-body extracts for hyposensitization are numerous,'^"'^ but the major studies supporting their use are both retrospective and uncontrolled.'*"^" The failure of mixed stinging insect extracts to prevent anaphylactic reactions in treated patients has also been reported.^''^^ Furthermore, several well-controlled studies revealed no difference between whole-body extracts and placebos used for immunotherapy.'•''•^ Thus, in these studies, desensitization using whole-body extracts proved no more efficient for patients with a history of an anaphylactic reaction than the natural development of immunological tolerance that occurs without any therapy.

Venom Extracts in Diagnosis and Desensitization
There is considerable recent evidence that venom is the appropriate antigen for diagnostic and treatment purposes in patients with insect allergy.^^~^^ The allergic response causing the sensitivity to the insect sting appears to be directed to venom products.^ Venom present in whole-body extracts appears to be of insufficient quantity.